Utilization Manager, SW/ LMHC/ RN Klarman Eating Disorders

Responsible for carrying at patient care review program which facilitates the appropriate use of resources and quality of care.

JOB RESPONSIBILITIES AND STANDARDS OF PERFORMANCE:

Responsibility and Standards

1. Develop collaborative relationships with MCO’s including participating in third party on-site visits and appeals.

Weight: 20%

Responsibility and Standards:

2. Consult to administrative/clinical staff regarding utilization management related
issues.

Weight: 15%

Responsibility and Standards:

3. Participates in 2 x /week clinical rounds, or otherwise reviews cases with clinicians.

Weight: 15%

Responsibility and Standards:

4. Performs telephone reviews with managed care staff.

Weight: 20%

Responsibility and Standards

5. Makes appropriate EPIC entries and assists Patient’s Financial Services Department when indicated.

Weight: 15%

Responsibility and Standards

6. Negotiates and processes single case agreements as needed.

Weight: 5%

Responsibility and Standards

7. Participates on McLean committees and assists in CQI efforts as needed.

Weights 5%

Responsibility and Standards

8. Assists in developing and refining department policies and practices.

Weights 5%

Education/Licensure:

RN, LICSW, LMHC, Ph.D., with current Massachusetts license

Skills:

Excellent clinical skills. Interpersonal, communication and organizational skills plus ability to make judgments are essential.

Experience:

Two years clinical experience, working with psychiatric in-patient population preferred. Previous utilization management experience preferred.

McLean is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.